A balanced energy-protein supplement fortified with multiple micronutrients could improve maternal health and pregnancy outcomes in vulnerable populations.
Findings revealed that the supplement contributed to improvements in maternal iron status and a reduction in anaemia prevalence, a major public health concern in low- and middle-income countries. A promising trend toward fewer small-for-gestational-age (SGA) births was also noted, suggesting that the supplement may help support foetal growth.
The supplement is a cost-effective and practical product, easy to integrate into existing antenatal care systems. It is a ready-to-mix, nutrient-rich food in the form of a 50 g powder sachet, formulated from maize, soy, and sorghum, and designed to be consumed as a shake. One sachet is mixed with 200 ml of clean water in a provided blender bottle and taken once daily between meals. In the study, it was distributed monthly during antenatal visits and, when necessary, delivered to participants’ homes.
Participants were divided into two groups. The control group received the standard antenatal care supplement of iron and folic acid (IFA) as routinely provided in South African public health care. The intervention group received a specially formulated balanced energy-protein (BEP) supplement fortified with multiple micronutrients (MMN) in addition to the standard IFA regimen.
This study was conducted by Dr Marita Serfontein, a successful dietician at an established private dietetic practice. Dr Serfontein, who recently relocated to Pretoria – where she aims to further expand her research portfolio and continue contributing to maternal and child nutrition – was awarded her PhD at the University of the Free State’s (UFS) autumn graduation ceremonies for her work regarding the impact of a food supplement on the nutritional status of pregnant women and the birth outcomes of their offspring.
Each serving of the supplement provided balanced macronutrients, including protein, fibre, and omega-3 fatty acids, as well as important micronutrients such as iron, folic acid, choline, and a range of vitamins and minerals known to support maternal health and foetal development. According to Dr Serfontein, the supplement was not intended to replace meals but to complement the existing diet, filling critical nutrient gaps without requiring cooking or refrigeration. “It’s convenience and familiar base ingredients made it suitable for daily use in resource-limited households,” she says.
Compromised access to healthy food health care
Dr Serfontein’s interest in maternal and child nutrition stems from her clinical experience as a dietitian, where she frequently saw the consequences of poor maternal nutrition on both mothers and their babies. “In resource-limited settings, where access to healthy food and quality health care is often compromised, women face a double burden of malnutrition and infection. I wanted to explore practical, evidence-based strategies to improve maternal health and pregnancy outcomes in these vulnerable populations,” she says.
The study was conducted in Kroonstad, and participants were recruited from public health-care facilities, including antenatal clinics and the local district hospital. This setting reflects the typical challenges faced in low- and middle-income communities, such as food insecurity, limited access to diverse foods and health care, and a high burden of infectious and inflammatory conditions that can impact maternal and child health.
According to Dr Serfontein, women in these environments often face multiple barriers to good health, including poverty, undernutrition, and high rates of conditions such as HIV. “Many live in single-headed households and experience financial insecurity, with limited access to health care and nutritional support. Teenage pregnancies are also prevalent, compounding the vulnerability of young mothers and their babies. Even when food is available, it may lack the important nutrients needed during pregnancy.”
“My study examined how a targeted nutritional intervention, designed to address both energy and micronutrient needs, could support women facing these complex challenges,” she states.
She found that many women showed signs of malnutrition, including anaemia and deficiencies in nutrients such as iron and vitamin A. Inflammation, which is known to interfere with nutrient absorption and metabolism, was also common. “These overlapping issues can worsen maternal health and foetal development. The study highlighted the importance of addressing both dietary intake and underlying inflammation in pregnancy care.”
Study aligns with global research
Dr Serfontein indicates that the findings of this study align with global research showing that balanced energy-protein (BEP) supplements fortified with multiple micronutrients can improve maternal nutritional status and support foetal growth, particularly in undernourished populations. Global reviews, including those led by the World Health Organisation (WHO) and the Cochrane Collaboration, support such interventions as effective in reducing maternal undernutrition and related complications.
Results also support the WHO goal of reducing anaemia in women of reproductive age by 50% by 2025 and highlight the need for strategies that fit specific local needs.
She points out that her research also contributes to the broader development agenda outlined in the Sustainable Development Goals (SDGs), including SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).
Dr Serfontein’s research also supports the need for multisectoral approaches that extend beyond supplementation to address maternal nutrition comprehensively. A holistic strategy, including early access to antenatal care, targeted nutritional programmes, social support, and public health policies addressing food insecurity, is important for improving maternal health, particularly in low- and middle-income countries. Emphasising early and targeted interventions during pregnancy, the findings advocate moving away from universal solutions to strategies that consider the unique nutritional needs of pregnant women. By integrating fortified energy-protein supplements into antenatal care alongside measures such as infection screening and equitable health-care access, these efforts could reduce maternal anaemia, promote foetal growth, and break cycles of malnutrition.